Medicine and Health Sciences Commons^™

Supraclavicular Blocks For The Treatment Of Distal Injuries In The Upper Extremity In The Emergency Department, Patrick O'Brien

Doctor of Nursing Practice Projects

Opioid addiction in the United States has increased, and interventions needs to be put into place to manage pain with fewer opioids. Alternatives like peripheral nerve blocks can be used to aid in pain management for acute injuries like ankle and wrist fractures. The purpose of this project is to develop and create a regional anesthesia protocol for acute upper and lower extremity fractures in the emergency department (ED) at Passavant Hospital in Jacksonville, Illinois, with the long-term goal of a reduction in opioid administration. An educational Power Point presentation was provided for the ED and the anesthesia personnel on …

Heart Failure Knowledge Among Cnas In A Skilled Nursing Facility: A Pilot Project, Amanda Mcdannald

Doctor of Nursing Practice Projects

Heart failure (HF) is one of the leading causes of hospitalization among patients over the age of 65 years. Many are transitioned to skilled nursing facilities (SNF) following hospital discharge. HF-specific SNF staff education was designed for early detection of changes and improved management of this patient population. Computer-based education modules and hands on skill demonstration stations were created to provide basic HF knowledge and specific guideline recommended care measures for the SNF environment. A pretest, post-test, and skill demonstration were implemented and included weight assessment, application of compression stockings, volume status monitoring, and low sodium diet recommendations. Pretest scores …

Utilizing Team-Based Care To Improve Rural Cardiovascular Care, Amanda Clouser, Kastin Engeling, Kris Rhodes

Doctor of Nursing Practice Projects

Cardiovascular morbidity and mortality are significantly higher among individuals living in rural areas compared to urban and suburban settings. Some contributing factors include financial limitations, education level, and limited access to cardiovascular specialty healthcare. Using a team-based cardiovascular care approach in rural communities, including both nurse practitioners and physicians, could help improve access to cardiovascular health services. The purpose of this project was to conduct a focus group interview to evaluate a team-based care approach to cardiovascular services implemented in a rural clinic located in a medically underserved area. Based on the results of the focus group interview, an evidence …

Improving Emergence And Awaken Time In The Obese Population: Development Of A Desflurane Protocol In The Obese Population, Nikki Watson

Doctor of Nursing Practice Projects

Studies have shown that obese patients are at an increased risk for apnea and aspiration during the postoperative period due to comorbidities associated with obesity (Nason, 2015). Complications such as apnea and aspiration can increase the length of stay in the post-operative care unit (PACU). Slower emergence further increases the risk for apnea and aspiration because of delayed return of protective reflexes (Brousseau, Dobson, & Milne, 2014). Evidence-based research has shown Desflurane to have the fastest wake-up times in obese patients when compared to Sevoflurane, Isoflurane, and Propofol (Juvin, Vadam, Malek, Dupont, Marmuse, & Desmonts, 2000). The goal of this …

Popliteal Blocks For The Treatment Of Distal Injuries In The Lower Extremity In The Emergency Department, Jacob Turner

Doctor of Nursing Practice Projects

Opioid addiction in the United States has increased, and interventions needs to be put into place to manage pain with fewer opioids. Alternatives like peripheral nerve blocks can be used to aid in pain management for acute injuries like ankle and wrist fractures. The purpose of this project is to develop and create a regional anesthesia protocol for acute upper and lower extremity fractures in the emergency department (ED) at Passavant Hospital in Jacksonville, Illinois, with the long-term goal of a reduction in opioid administration. An educational Power Point presentation was provided for the ED and the anesthesia personnel on …

Hand-Off Tool Implementation In Post-Anesthesia Care, Benjamin Nash

Doctor of Nursing Practice Projects

The issues surrounding the safety of patients and improving patient care outcomes in the pre-operative and post-operative environment, is one of ongoing focus and development. Post-operative, hand-off report is one aspect in the continuity of patient care that has affected patient outcomes. Clear, concise, and accurate communication concerning patients and their postoperative status is one way that providers and caregivers may ensure patient safety. There are many various organizations that emphasize the importance of clear, effective communication, in the form of a standardized hand-off tool to maximize patient safety. The purpose of the project was to standardize clear, concise, effective …

Implementing An Enhanced Recovery After Surgery Protocol In A Critical Access Hospital, Joseph Grazaitis

Doctor of Nursing Practice Projects

Enhanced recovery after surgery (ERAS) protocols provide numerous benefits for patients undergoing colorectal surgery. The goal of the protocol is to decrease surgical complications, patient’s length of hospital stay, recovery time, and increase patient satisfaction. The purpose of this doctoral project was to create and implement an ERAS protocol for a 25-bed critical access hospital. The findings obtained from the literature review were presented to the multi-disciplinary team. The specific needs of the surgical team were identified, and the ERAS protocol was created. Lastly, the ERAS protocol was finalized and implemented in the institution. The outcome measures examined were the …

Improving Perioperative Warming Of Surgical Patients: Implementation Of A Warming Protocol, Maghy Schrage

Doctor of Nursing Practice Projects

Despite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.

The project study …

Improving Allergy Immunotherapy Adherence, Amy Branham

Doctor of Nursing Practice Projects

Allergen Immunotherapy (AIT) is an effective treatment for allergic rhinitis. However, at a Midwest teaching clinic, patients tend to not complete the entire course of immunotherapy. AIT adherence is suboptimal due to a multitude of reasons. The purpose of this project is to increase adherence to AIT by implementing the following evidence based interventions; a text message reminder, a communication/education template, and through increasing clinic accessibility. Initial implementation involved working with clinic personnel to develop the content of the reminder texts and of additional educational materials. Subsequently, the changes were executed at the beginning of fall. Over the following three …

Adequate Pain Control With Ofirmev To Minimize Narcotics Consumption And Its Side Effects, Gideon Nkrumah

Doctor of Nursing Practice Projects

Typically, perioperative pain has been managed with opioids, however, the extreme use of opioids has been associated with respiratory depression, excessive sedation, drowsiness, nausea, vomiting, ileus, severe constipation, prolonged hospital stay, addiction, and dependence. The American Society of Anesthesiologists Task Force on Acute Pain Management recommends that patients should always receive non-opioid analgesics like Acetaminophen and NSAIDs as first-line agents so that opioids can be used as adjunctive agents to minimize opioid-related side effects, addiction, and dependence (The American Society of Anesthesiologists, 2011).

A protocol was developed to help providers use Ofirmev effectively and efficiently. The goals of this project …

Implementation Of Crisis Checklists In The Operating Room, Gregory S. Feilner

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Utilizing Simulation To Implement Cognitive Aids In The Operating Room, Kaitlyn Brown

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Development Of A Guideline To Reduce Spinal Induced Hypotension And Related Nausea And Vomiting In Patients Undergoing Scheduled Cesarean Section, Peter Gillen

Doctor of Nursing Practice Projects

Cesarean sections performed under spinal anesthesia frequently involve spinal-induced hypotension and can result in intraoperative nausea and vomiting for the patient. This project involved the development of a guideline to combat this problem using lower sequential devices, co-loading of crystalloid fluids, and prophylactic administration of intravenous ondansetron. The guideline was presented to anesthesia providers at a tertiary care facility in Southwestern Illinois. Evaluation of the project included pre and post-tests as well as post-implementation surveys of the providers. The pre-test results indicated a need for further education among providers to address the problem. The post-test scores achieved the goal of …

Implementing Routine Hiv Testing And Prevention In A Primary Care Setting, Michelle Bassett

Doctor of Nursing Practice Projects

Evidenced-based research has identified that routine HIV testing and education is pivotal in identifying new infections, providing access to treatment, and decreasing the rates of transmission. In 2006, the CDC implemented new guidelines recommending that all persons aged 13-64 years be tested yearly for HIV regardless of risk factors. Despite these recommendations, the CDC estimated that less than 37% of people were tested in 2017 and in the years prior. In this project, a protocol for routine testing and education was developed and implemented in a private Southern Illinois primary care practice. Providers and staff were educated on HIV and …

Improving Patient Education On Spinal Anesthesia: An Assessment Of A Patient Educational Program, Nicholas Raburn

Doctor of Nursing Practice Projects

Abstract

Spinal Anesthesia (SA) is a common type of anesthesia that is frequently used for surgeries of the lower abdomen, lower extremities, and perineal area. Spinal anesthesia offers fewer side effects and risks than General Anesthesia (GA). Patients usually recover their senses much faster with SA (MedlinePlus, 2017). Some patients often refuse SA due to fears and misconceptions. These misconceptions are related to a lack of education and resources available to patients. It is crucial that anesthesia providers learn to adequately educate patients preoperatively on the use of SA. Anesthesia providers in a community hospital in southern Illinois educated patients …

Enhancing Iana Member Communication & Engagement, Bart Bowers

Doctor of Nursing Practice Projects

The National Provider Identifier (NPI) Registry data identifies CRNAs as the sole providers of anesthesia for 29% of counties in the state of Illinois (“Illinois CRNA Map,” n.d.). These CRNAs, therefore, should play an important role in advocating for access to high quality care. While IANA is a vigorous advocate with regards to patient access to high quality, affordable health care (Bickel, 2017), the long-term patient advocacy capabilities of IANA are at risk due to a declining trend in membership numbers (Farina et al., 2016; Flores, 2014; “Keeping Pace,” n.d.; Yohn, 2016). Traditional forms of communication utilized by IANA, such …

Improving Perioperative Pain Management: Development Of An Adult Lidocaine Infusion Protocol, Kelsey Wallace

Doctor of Nursing Practice Projects

Abstract

Postoperative pain is a challenge in healthcare, with more than 50% of patients reporting inadequate pain control (Zengin, Saracoglu, Eti, Umuroglu, & Gogus, 2015). Inadequately controlled pain can negatively impact a patient’s quality of life, recovery, and cause postsurgical complications (Chou et al., 2016). Aims for acute pain management focus on reducing the incidence and severity of pain in order to improve patient function, minimize side effects, and prevent further complications (Gordon et al, 2016). Implementing a multimodal approach to pain control that includes a lidocaine bolus followed by continuous infusion has resulted in reduced opioid consumption, fewer adverse …

Update Of Blood Transfusion Protocols At A Regional Hospital In Rural Illinois, Kendra Tracy

Doctor of Nursing Practice Projects

The chief nursing officer (CNO) at a small regional hospital in rural Illinois requested an update to their blood transfusion policy and protocol based on current evidence-based information. These documents were updated with current information on safe assembly and delivery, identification of transfusion reactions, and appropriate responses to these reactions. In collaboration with the CNO and Quality Improvement Committee (QIC), drafts of a new policy and protocol and a Blood Transfusion Skills Checklist were developed. These documents were presented at a hospital-wide Skills Lab Day to registered nurses employed at the facility. A Likert Scale evaluation survey was presented to …

Treating Acute Bronchitis In Primary Care, Haylie Patterson, Stacy Wieland

Doctor of Nursing Practice Projects

There has been a significant rise in inappropriate antibiotic prescribing in the United States with at least 30 percent of antibiotics prescribed deemed unnecessary (Fiore, Fettic, Wright, & Ferrara, 2017). Overprescribing antibiotics for viral illnesses such as acute bronchitis leads to antimicrobial resistance. Based on current treatment guidelines, most upper respiratory infections do not respond to antibiotics but rather require supportive measures. Antibiotic prescribing trends for a Midwestern rural clinic were obtained through a retrospective and prospective chart review. Patients were frequently receiving antibiotics for acute bronchitis. To approach the problem a quality improvement (QI) evidence-based project was proposed. A …

Improving Acute Pain Management: Development Of An Adult Dexmedetomidine Infusion Protocol, Timothy Denney

Doctor of Nursing Practice Projects

Studies have revealed over 80% of surgical patients experience acute postoperative pain: 75% of patients describe pain levels as moderate, severe, or extreme (Chou et al., 2016). Opioids continue to be the mainstay of most postoperative analgesia regimens (Tan, Law, & Gan, 2015). While effective for the treatment of severe pain, opioid use also prolongs length of hospital stay and places patients at greater risk for higher adjusted mean costs due to dose-related side effects. Multimodal analgesia is a concept that continues to gain momentum to improve perioperative analgesia while reducing the incidence of opioid-related adverse events (Buvanendran & Kroin, …

Integration Of Mental Heath Screening Protocol In Primary Care For Patients Who Have Experienced Traumatic Events, Karra N. Adams

Doctor of Nursing Practice Projects

Mental health status is not always assessed in patients involved in a physically traumatic event unless the patient expresses concern. Often times, orthopedic injuries are a result from a traumatic event. Routine mental health screening in the primary care orthopedic setting can help identify mental health care needs early so that adequate interventions can be implemented in a more effective manner. The goal of this project was to evaluate the feasibility of incorporating the use of a brief mental health screening tool in a primary care setting to assess the psychological needs of patients who have been involved in a …

Implementation Of Emergency Severity Index Training To Improve Accuracy Of Triage Levels, Erinn Hileman, Douglas Mckain

Doctor of Nursing Practice Projects

This quality improvement project was created to help increase knowledge of the Emergency Severity Index (ESI) in the Emergency Department (ED), a form of triage used to categorize patients by their acuity. Proper ESI use shortens the length of stay times, door to provider times and reduces the number of patients that leave without being seen.

The goal of this project was to develop an online learning module that would increase the nurses’ knowledge of triage to enhance triage accuracy. Nineteen (19) emergency department nurses were given a pretest, an ESI educational presentation, and a follow-up post-test.

Data analysis indicated …

Development And Evaluation Of A Malignant Hyperthermia Computer Based Learning Project, Andrew Miller

Doctor of Nursing Practice Projects

Malignant hyperthermia (MH) is a potentially fatal, inherited disorder of muscle hypermetabolism that occurs after a person is exposed to commonly used volatile anesthetic agents (sevoflurane, desflurane, isoflurane) and/or the depolarizing muscle relaxant, succinylcholine (Diu & Mancuso, 2012). The MH mortality rate has decreased from 80% in the 1960s to less than 5% in 2006 due to increased clinical awareness of manifestations, pathophysiology, and improvement in perioperative monitoring (Rosenberg, Pollock, Schiemann, Bulger, & Stowell, 2015). Therefore,continuing education of perioperative staff is an integral part of proper MH preparedness. Computer-based learning (CBL) modules have been shown to be efficient, inexpensive forms …

Increasing Utilization And Awareness Of An Existing Patient Portal Application, Amanda Graham, Jessica L. Schnebly

Doctor of Nursing Practice Projects

Patient portal applications (PPAs) are secure website or computer/mobile device applications that allow 24-hour access to a patient’s electronic health record (EHR). Patient portal applications are intended to improve quality and access to health care by engaging patients to be more active in managing and monitoring their health. A large Midwest multispecialty organization’s Follow My Healthpatient portal application (FMH app) is underutilized by patients and providers. While evidence supports the use of web-based patient portal applications, only 17% of this organization’s patients use the FMH app, and even less use its direct messaging capabilities.

The purpose of this project …

Assessing Palliative Care Needs In Residents With Alzheimer's, Emily Yarnell

Doctor of Nursing Practice Projects

Current evidence indicates a lack of assessment protocols focusing on palliative care needs for patients with Alzheimer’s disease. This gap in practice supported the need to implement an evidence-based assessment protocol for early identification of palliative care needs in patients with Alzheimer’s disease residing in a long-term care facility. The protocol included using the patient’s Global Deterioration Scale (GDS) score to determine the patient’s palliative care needs according to the Dementia Progression Prioritization of Goals model. If the score indicated moderate to severe Alzheimer’s disease, then their goal was maximization of comfort, indicating a need to begin palliative care plans. …

Improving Acute Postoperative Pain Management For The Pediatric Patient: Guidelines On The Use Of Intravenous Dexmedetomidine, Jenna Winters

Doctor of Nursing Practice Projects

Inadequately treated surgical pain in children leads to risky complications, such as longer recovery times, infection, prolonged hospitalizations, readmissions, altered pain sensitivity, neurophysiological changes, and cognitive-behavioral abnormalities (Campbell, 2013; Ibrahim, Jones, Lai, & Tan, 2016). Review of the literature indicated intravenous dexmedetomidine, as an adjunct, may lead to improved outcomes and a reduction in postoperative pain in children undergoing surgical intervention. An evidenced-based educational presentation introduced intravenous dexmedetomidine in children to anesthesia professionals, pharmacy staff, and the pediatric care team at a tertiary care center. Concluding the educational presentation, participants completed a voluntary survey evaluating the effectiveness of the presentation. …

Hepatitis C Virus Screening And Treatment, Dani Loftus, Emily Machens, Crista Jamous

Doctor of Nursing Practice Projects

Hepatitis C Virus (HCV) is classified as a contagious liver disease that can be either acute or chronic, and the illness ranges in severity from mild to lifelong. It is estimated that 2.7 million people in the United States (US) have HCV, but only half are diagnosed. The CDC recommends testing by birth-cohort, focusing on adults born between 1945 and 1965. Three main objectives for this project included implementation of a clinical decision support system (CDSS) for providers, increasing HCV screening by providing education to the support staff in primary care clinics of a local hospital which would increase the …

Transitioning Pediatric Patients With Special Needs, Dimi Resch

Doctor of Nursing Practice Projects

Transitional care, which encompasses both the sending and receiving aspects, is essential for pediatric patients with complex care needs.A provider in a small, Midwest pediatric primary care clinic agrees with researchers that transitional guidelines are needed for consistency among pediatric and adult providers. This clinic currently has no process in place to guide the transition of patients with special needs. The primary goal of this project was to develop a communication tool that aids in the transition of patients with special needs into the adult primary care setting. The literature reviewed provided a variety of tools used to communicate healthcare …

Transition Of Care From Pediatrics To Adult Health Care, Heather Mahsman, Holly J. Henderson

Doctor of Nursing Practice Projects

Transition planning is essential for continuity of healthcare for adolescents approaching adulthood. Transition of care should start in early adolescence to help pediatric patients find and establish an adult healthcare provider. The purpose of this project was to assess and increase awareness of transition planning and assess the feasibility of instituting a transition program in a rural health pediatric clinic. Staff and providers were educated about transition of care planning and current recommendations from the American Academy of Pediatrics. Pre and post surveys were collected. Staff reported the program as beneficial to their patients and would like to see further …

The Hemoglobin A1c Of African-Americans/Blacks With Diabetes Mellitus Type Two Using Low-Fat Diabetes Plate Diet, Ednah K. Makori

Doctor of Nursing Practice Projects

Diabetes Mellitus type two (DMT2) is a chronic disease that leads to high blood sugar in the body and if not corrected over a period of time, it leads to development of complications. Some of those complications include blindness, kidney failure, and retinopathy, among others. DMT2 continues to affect many people in the USA, especially African-Americans/Black who have the highest prevalence as compared to other races. Proper diet management especially the Low-Fat diabetes diet helps to decrease Hemoglobin A1c, which could result in reduction of risk of developing complications and morbidity related to DMT2. This project was done to educate …